SF-425 Federal Financial Report 4040-0014

Forms and Documents

Document Name	Status
Form 4040-0014 SF-425 F SF-425 Federal Financial Report 4040-0014 Form	New
Form SF-425A Federal Financial Report Attachment Form	Removed
Form SF-425 Federal Financial Report Form	Removed
OMB comments on Grants.gov Standard forms - GrantsGov Response v2.xlsx Supplementary Document	2016-01-14
4040-0014_FFR_SS_FINAL_2015_v1.1.doc Supporting Statement A	2016-01-14

IC Document Collections

IC ID	Document Title	Status
218371	SF-425 Federal Financial Report 4040-0014 Form	New
186152	Federal Financial Report Attachment Form	Removed
186151	Federal Financial Report Form	Removed

ICR Details

OMB Control No: 4040-0014	ICR Reference No: 201509-4040-005
Status: Historical Active	Previous ICR Reference No: 201307-4040-004
Agency/Subagency: EGOV	Agency Tracking No:
Title: SF-425 Federal Financial Report 4040-0014
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/15/2016
	Date Received in OIRA: 10/20/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved	02/28/2015
Responses	100,000	0	1,200,000
Time Burden (Hours)	100,000	0	1,200,000
Cost Burden (Dollars)	0	0	0

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Abstract: This is a standard governmentwide form for grantees to use in reporting financial status and cash disbursement under grants.

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Authorizing Statute(s): PL: Pub.L. 106 - 107 3(2) Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 65961	11/06/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 7596	02/11/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Federal Financial Report	SF-425	Federal Financial Report
Federal Financial Report Attachment	SF-425A	Federal Financial Report Attachment
SF-425 Federal Financial Report 4040-0014	4040-0014 SF-425 Federal Financial Report	SF-425 Federal Financial Report

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	100,000	1,200,000	0	-1,100,000	0	0
Annual Time Burden (Hours)	100,000	1,200,000	0	-1,100,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The form is now being classified as a Common Form. Burden hours are reported for HHS only. Other Federal grant-making agencies using the form are responsible for reporting burden hours.

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Annual Cost to Federal Government: $3,900,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 5 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage:  Recipients of financial assistance from any of the Federal grant-making agencies are required to use this form. HHS is responsible for renewal and reporting of burden hours for the 4040-0014. Other Federal agencies that wish to use the form are required to file a request for use from OMB and report burden hours accordingly.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title
USDA/AMS	201602-0581-010CF	Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
DOI/ONRR	201604-1012-005CF	SF-425 Federal Financial Report usage for ONRR	Historical Active	SF-425 Federal Financial Report 4040-0014
DOI/OSMRE	201605-1029-005CF	Request to use SF-425 - Federal Financial Report- State, Local & Tribal Govt. for OSMRE	Historical Active	SF-425 Federal Financial Report 4040-0014
DOI/BLM	201606-1004-009CF	BLM - 425, Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
DOI/NPS	201609-1024-009CF	SF-425 - Federal Financial Report common form usage for NPS.	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RHS	201605-0575-004CF	SF-425 -- Financial Status Report	Historical Active	SF-425 Federal Financial Report 4040-0014
DOI/BIA	201610-1076-001CF	SF 425 - Federal Financial Report for BIA Use	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RUS	201701-0572-017CF	Federal Financial Report SF 425	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/AMS	201610-0581-016CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
USDA/RHS	201607-0575-012CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
USDA/RBS	201612-0570-014CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/APHIS	201702-0579-015CF	Federal Financial Report (4040-0014)	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
USDA/NIFA	201702-0524-067CF	Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RUS	201701-0572-024CF	Federal Financial Report SF-425	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RBS	201605-0570-009CF	SF-425 - Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
DOT/FAA	201704-2120-005CF	Aviation Research Grants Program	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/FNS	201706-0584-012CF	SF-425 Federal Financial Report (FNS)	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
DOC/NTIA	201709-0660-013CF	Federal Financial Report (SF-425) for 911 Grant Program	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RUS	201707-0572-030CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
USDA/AMS	201901-0581-003CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
DOT/FAA	201901-2120-001CF	Aviation Research Grants Program	Historical Active	SF-425 Federal Financial Report 4040-0014
DOI/FWS	201807-1018-010CF	SF-425 Federal Financial Report usage for USFWS	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RHS	201806-0575-030CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RUS	201710-0572-035CF	Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RBS	201802-0570-043CF	SF-425, “Federal Financial Report”	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/FS	201802-0596-013CF	Federal Financial Report (SF-425)	Historical Active	SF-425 Federal Financial Report 4040-0014
DOT/FMCSA	201809-2126-005CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RHS	201810-0575-005CF	SF-425 Federal Financial Report	Historical Active	SF-425 Federal Financial Report 4040-0014
USDA/RUS	201804-0572-047CF	Financial Status Report (SF-425)	Historical Active	SF-425 Federal Financial Report 4040-0014, SF-425 Federal Financial Report 4040-0014
DOI/OSMRE	201605-1029-006CF	Request to use SF-425 - Federal Financial Report - Private Sector for OSMRE	Historical Active	SF-425 Federal Financial Report 4040-0014

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/20/2015

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